How physician advocacy shaped health care in 2016

The evolving health care system requires a strong physician voice to keep it headed in the right direction. Here are a few ways that voice impacted health policy this year. 

The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the flawed sustainable growth rate formula in 2015. In 2016, regulations were issued to create the new Quality Payment Program (QPP). As a result of efforts by the AMA and other organized medicine groups, physicians have a much greater opportunity for success under Medicare’s physician payment system, the QPP.

In the first year of the program, physicians will not receive penalties if they simply report on one measure for one patient thanks to the addition of “Pick Your Pace.” Those who choose to report more data for the year may be eligible for significant bonus payments. Physicians spoke up and the AMA pressed CMS to create a transition year that allows physicians to ease into the new program. Andy Slavitt, acting administrator of CMS, listened and, in addition to Pick Your Pace, changed much of the program in the final rule.

Reporting burdens were significantly reduced, with fewer measures required and a 90-day reporting period rather than full-year reporting. CMS removed some challenging EHR measures, such as computerized physician order entry and clinical decision support, from the QPP. The 29 percent of physicians who have a low volume of Medicare patients—fewer than 100 patients or less than $30,000 in Medicare revenue—will be exempt from penalties and reporting requirements. Small practices received specific accommodations in the final rule and will benefit from lower reporting burdens and technical assistance. And, due to AMA advocacy, the final QPP policies provide a more welcoming environment for physicians interested in APMs.

The AMA has developed a collection of tools and resources to help practices prepare for Medicare changes.

Through the work of the nation’s medical societies and the AMA’s Task Force to Reduce Prescription Opioid Abuse, notable progress was made toward reversing the nation’s opioid overdose epidemic. A nationwide physician awareness campaign contributed to a 10.6 percent drop in opioid prescriptions, greater use of prescription drug monitoring programs (PDMP), increased physician education and expanded access to naloxone.

Patients will have greater access to medication-assisted treatment for opioid use disorder, and hospital payments will no longer depend on patient satisfaction survey questions that can unintentionally promote opioid prescribing.

AMA Wire® spoke with several physicians this year on how to work with patients to prevent overdose, reduce stigma, use PDMPs and manage chronic pain.

Mergers between major health insurers Aetna Inc. and Humana Inc., and Anthem Inc. and Cigna Corp. were announced in July 2015. Since then, the AMA led a successful effort to convince the U.S. Justice Department and several state attorneys general to block the mergers—as well as insurance commissioners of both Missouri and California.

The foundation of this effort was the 15th edition of Competition in Insurance: A Comprehensive Study of U.S. Markets, published in September by the AMA. The study supported the argument that the two mega-mergers would exceed federal antitrust guidelines designed to preserve competition, which would also negatively affect patient access to affordable coverage and care. The study, combined with an AMA-generated physician survey and collaboration with medical associations and patient coalitions, ensured that the physician voice was heard by federal and state regulators.

In response to nationwide concerns about the rising cost of prescription drugs, the AMA launched a grassroots campaign, TruthinRx.org, calling on pharmaceutical companies, pharmacy benefit managers and health insurers to provide more transparency regarding costs, pricing and financial practices. The campaign is also collecting and sharing patients’ stories of how rising drug costs have affected their lives and access to health care.

With the release of the Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Service (CMS) made a landmark decision to provide coverage for diabetes prevention programs (DPP). This is a major victory. With coverage, the AMA’s work with physicians and health systems across the nation to prevent diabetes will see an expansion in 2018.

The AMA also established a partnership with Omada Health and Intermountain Healthcare to develop an online DPP to overcome challenges of geography and feature a social experience similar to that of an in-person program.